Discovering and Supporting Temporal Cognition in Complex Environments

Discovering and Supporting Temporal Cognition in Complex Environments Christopher Nemeth (cnemeth@uchicago.edu) Cognitive Technologies Laboratory, The University of Chicago MC4028, 5841 S. Maryland Avenue, Chicago, IL 60637 USA Richard Cook (ri-cook@uchicago.edu) Cognitive Technologies Laboratory, The University of Chicago MC4028, 5841 S. Maryland Avenue, Chicago, IL 60637 USA Abstract Building new information tools to support cognitive work requires research at a level that, within the constraints of time and resources, will reveal higher-order cognition among practitioners. Practitioners develop cognitive artifacts in order to perform technical work. As densely encoded representations of work domains, their artifacts embody the most meaningful information in the task setting. The study of cognitive artifact development and use makes it possible to study individual and team cognition. This approach reveals what information is important, and how practitioners capture and use it. As replicas of physical artifacts, digital cognitive artifacts often amount to only meager representations of what matters in the work environment. This clumsy automation imposes a burden on practitioners by forcing them to cope with its shortcomings. In this setting, user-centered automation must support reasoning through time. The study of physical artifacts indicates ways that digital artifacts might better support temporal reasoning. Use of Cognitive Artifacts to Understand Technical Work The coordination of anesthesia assignments at a major urban teaching hospital spans 50 to 80 cases a day and requires the orchestration of multiple departments including anesthesia, surgery, nuclear medicine, obstetrics and gynecology, gastrointestinal endoscopy, diagnostic and interventional radiology, and psychiatry. This activity involves a distributed cognition (Hutchins, 1995), that is comprised of the shared awareness of goals, plans, and details that no single individual grasps. Through socially distributed cognition (Perry, 1999), individuals cultivate the mutual awareness and understanding that is needed to collectively accomplish shared goals. Surgeons, anesthesiologists and the others at the hospital work to a Standard of Medical Expertise (SME). Resources among care settings, patient populations and system are constrained and must be allocated prudently in order to meet a Standard of Resource Use (SRU). (Sharpe and Faden, 1998). A few of the senior anesthesiologists serve in the role of daily coordinator, assigning staff to perform a full schedule of anesthesia, sedation or pain management procedures each weekday. To do this, the coordinator must evaluate the number and types of procedures, determine the number and types of staff available, assign staff to perform procedures, and evaluate the balance between the two. The coordinator typically manages the execution of that schedule on the following day. Management of this process involves the synchronization of complex, changing activities through time. This requires an accurate grasp of the number and nature of available staff as well as an accurate, up-to-the- minute account of procedures that have been performed so far, are underway, and have yet to be performed within work setting constraints. Research into cognitive activity in this setting is challenging for a number of reasons. Healthcare practitioners may have little insight into how their work is organized. Information and interaction at the sharp (operator) end is dense, complex, varies widely, and changes rapidly. (Cook and Woods, 1994) In order to understand cognition in this environment, the researcher needs to employ a number of methods. Woods and Roth’s (1988) cognitive engineering approach studies behavior in actual environments in order to change behavior and to improve performance. Klein’s (2000) naturalistic decision making (NDM) approach accounts for the performance of decision makers in actual settings. Hutchins’ (1995) ethnomethodology describes how distributed cognition includes artifacts that make it possible for a group to accomplish shared goals. The development and use of cognitive artifacts makes it possible to perform the otherwise impossible process of assignment coordination. Cognitive artifacts are an efficient representation of what matters here because they represent only the information that is critical in this work domain. Previous work (Nemeth 2002, 2003a) describes the use of observational studies to discover how the acute care team uses cognitive artifacts to make the plan for the day’s work. It also explains how controlled study of artifact creation reveals the strategies that coordinators employ in order to create a feasible future for the next day of procedures. Two artifacts are essential to the coordinator while developing a plan. The Daily Availabilities sheet is used to account for the status of each of the members in the department who are available for assignment. The preliminary copy of the Master Schedule lists all procedures that are scheduled to be